The Old School House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment this key question was rated Good. At this assessment the rating has improved to Outstanding. People were protected by a service that combined exceptionally strong safeguarding practices, personalised risk management, positive risk-taking and an embedded culture of learning and continuous improvement. Leaders and staff worked proactively with people, families and professionals to minimise harm whilst promoting independence, choice and quality of life. Learning from incidents resulted in meaningful improvements, restrictive practices were continually reduced wherever possible and people consistently experienced safe, coordinated and highly personalised care.

This service scored 91 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong, proactive and positive culture of safety, based on openness, transparency and honesty. Leaders monitored risks and worked collaboratively with both their own staff and external professionals to ensure lessons were learnt, shared and embedded in practice. Improvements were measurable and had a positive impact on people’s safety, wellbeing and quality of life.

People experienced exceptionally safe care because leaders embedded a proactive culture focused on prevention, learning and continuous improvement. Learning was used proactively to drive meaningful and sustained improvements which positively impacted people's safety and wellbeing. Staff listened to concerns about safety and worked towards preventing them. When any safety incidents had happened, which were rare, these were thoroughly investigated and immediately reported to the appropriate organisations.

One staff member told us, "If something goes wrong, we don't look for someone to blame. We look at what happened, what we can learn and how we can make things better for people."

The service demonstrated an exceptional ability to learn from events. Following significant choking incidents, leaders worked alongside families, hospital teams, SALT professionals and primary care services to review care and treatment arrangements comprehensively. The reviews explored communication, care delivery, escalation procedures, staff knowledge and clinical decision making. As a result, care plans were strengthened, additional dysphagia training was introduced, specialist equipment obtained and staff guidance enhanced. This learning resulted in safer care and improved support for people at risk of choking and aspiration.

The provider moved beyond simply identifying findings and implemented meaningful changes. These included enhanced specialist training for their staff, investment in equipment to support consistency, reviews of and improvements made to documentation/s, reinforcement of communication expectations with families and additional training. Lessons learned were documented and always shared with staff. Staff were provided time to reflect and due to the strong bonds staff had developed with the people they cared for, emotional support was offered and often provided to them individually or as a group.

The provider demonstrated openness and transparency throughout the investigative process. Outcome letters to relatives clearly explained their findings, actions taken and included apologies when appropriate. One letter stated the service remained committed to ‘openness, transparency and high standards of care.’ Families trusted in and were reassured by the providers comprehensive investigations, transparency and outcomes.

Staff described a culture where concerns were openly discussed through handovers, supervision, debriefs and other types of management support. Learning was viewed as an opportunity to improve outcomes rather than assign blame. This created a positive culture where staff felt confident raising concerns and regularly contributed innovative ideas that proved effective in continuously improving the service. For example, staff identified that communication at shift handovers could be further strengthened to ensure emerging risks and changes in people's wellbeing were consistently shared. Leaders supported staff to implement a quality improvement project using a Plan-Do-Study-Act (PDSA) approach, which led to the introduction of structured handover templates and the daily prompt, "Who are we worried about today?" Staff identified concerns earlier, shared information more effectively and responded proactively to deteriorating health and wellbeing. This resulted in safer care, improved continuity and better outcomes for people.

The provider worked collaboratively with people, relatives and external healthcare partners to design, establish and maintain safe systems of care, in which safety was proactively well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

People experienced safe, personalised and exceptionally well-coordinated care when moving into, out of, and within the service. Leaders and staff worked proactively with everyone involved to ensure transitions were carefully planned, risks were minimised and people's individual needs, preferences and wishes were consistently respected. The service went beyond expected practice to support people with complex needs to settle successfully, maintain important relationships and achieve positive outcomes.

The provider demonstrated particularly strong practice in supporting people moving from unsuitable or previous failed placements. Staff completed comprehensive pre-admission assessments and gathered information from people, relatives, previous placements and healthcare professionals to ensure they could safely meet people's needs before admission.

Leaders and staff worked as a proactive team so that people and their families were fully supported and all avenues explored to encourage a more positive journey with favourable placement outcomes for people. New residents received personalised support during periods of transition, including increased staffing where required, ongoing observation and regular review of care plans to ensure support remained appropriate and responsive as people settled into the home.

Relatives feedback described how successful and well managed transitions and outcomes were for people. One relative told us, "This is the first place that has really understood [name of person]" and, another relative described the service as, “The best place [name of person] has ever lived.’

Staff demonstrated exceptional coordination when people experienced significant changes in health needs. Records showed one person who experienced incidents was safely supported through hospital admission, multidisciplinary reviews and discharge planning. Staff worked closely with hospital teams, families and other professionals to develop clear plans which reduced future risks and promoted continuity of care. Learning from the incident resulted in additional staff training, equipment improvements and strengthened communication processes.

People and relatives consistently described feeling safe and reassured by the service. One relative told us, "When I walk away, I know [name of person] is in safe hands." Another relative explained that since admission their family member's needs were anticipated and met by staff, resulting in improved outcomes and reduced anxiety for family members. These comments reflected the confidence relatives had in the provider's ability to safely support people through admissions, changing needs and ongoing care.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They created a culture where safeguarding was everybody’s responsibility. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Strong leadership oversight, excellent partnership working and a commitment to continuous learning ensured people experienced exceptionally safe care and support.

Robust safeguarding systems were deeply embedded within the culture of the service. Policies and procedures reflected local multi-agency safeguarding arrangements. Staff demonstrated an excellent understanding of safeguarding responsibilities, the different types of abuse and the actions required to protect people. Staff described an open and transparent culture where concerns could be raised immediately and escalated without fear. One staff member told us, “No one is afraid to go to their line manager to discuss anything, whether big or small concerns” and another staff member told us, "If I raised a safeguarding concern, I know it would be acted on straight away." People and relatives consistently described feeling safe, reassured and confident in staff's ability to protect people whilst maintaining their independence and rights.

Safeguarding concerns were investigated thoroughly, referred appropriately and used as opportunities for learning. Records showed safeguarding incidents were reviewed through structured processes which included fact-finding, informing appropriate agencies, family involvement and clear management oversight. Learning was shared with staff and used to improve practice within the service.

People can only be deprived of their liberty to receive care and treatment when this is lawful and appropriately authorised. Restrictions on people’s freedom were applied for through a Deprivation of Liberty Safeguard (DoLs) and closely monitored to ensure they remained lawful, proportionate and in people’s best interests. A detailed tracker was maintained to ensure applications were monitored and any conditions complied with and reviewed as necessary. Staff demonstrated a strong understanding of the Mental Capacity Act and understood the importance of evaluation to ensure least restrictive practices were in place.

People and relatives consistently told us they felt safe. One relative said, “When I walkaway, I know [name of person] is in safe hands.” Another told us, “It is such a delight to go to sleep and not have to worry.” These accounts were all the more important, given the previous failed placements and lack of trusted relationships. This service had worked exceptionally hard to rebuild in these areas and staff had successfully achieved a higher standing in the eyes of the people and relatives they supported. Outcomes showed significant reductions in safeguarding alerts for people, because they were better understood and supported by skilled staff that had a passion to improve people’s experiences of care. This was not to be underestimated, the time, patience, ability to communicate well, understand distressed signals for each individual and the dedication needed to ensure people were successfully placed and remained settled throughout their care journey.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them. Staff completed thorough and detailed risk assessments, which considered positive risk-taking, where people were supported to live fulfilling lives.

People were actively involved in managing risks in ways that promoted their independence, choice and quality of life. Risk assessments were person-centred, regularly reviewed and developed with people, their families and relevant professionals. Staff consistently balanced safety with people's rights, preferences and aspirations, ensuring risks were managed in the least restrictive way possible.

Family involvement in care planning and risk management contributed to the successful reduction of enhanced support arrangements for people, while maintaining people’s safety, engagement and quality of life. Records following people’s transition to the service demonstrated reductions in restrictive practices, successful transitions from higher levels of support, increased community engagement, improvements in wellbeing and sustained family confidence in adult social care overall. The provider had further strengthened this personalised approach through regular ‘Family and Carer Listening Events’, which enabled families to influence care approaches, risk management strategies and wider service development. Relatives consistently reported feeling involved, listened to and reassured that risks were being managed effectively whilst respecting people’s wishes and rights. This demonstrated how the service worked collaboratively with families as partners in care to achieve positive outcomes through proportionate and personalised risk management rather than relying on restrictive interventions.

Risk assessments were enabling rather than restrictive. Staff demonstrated a clear understanding that positive risk-taking is essential to maintaining wellbeing and independence. For example, people and their relatives were supported to ensure access to community activities, family outings and meaningful experiences. In order to successfully facilitate this, staff carefully considered risk assessments and any family training or support to build confidence to use equipment. We observed instances during inspection where risks associated with mobility, falls, community access and behavioural distress were managed proactively whilst ensuring people could continue to participate in activities that mattered to them.

The service was committed to least restrictive practice and regularly reviewed support arrangements to maximise independence. Inspection evidence showed examples where enhanced one-to-one support had been safely reduced or removed following regular review and assessment of changing needs. Staff worked collaboratively with families and healthcare professionals to ensure restrictions were proportionate, necessary and regularly evaluated. This approach supported people to maintain maximum control over their lives whilst remaining safe.

People benefited from highly personalised risk management plans which reflected their individual histories, preferences, communication needs and behavioural triggers. Staff understood early warning signs of distress and used positive behaviour support strategies, reassurance and meaningful engagement before considering restrictive interventions. PRN medicines were clearly described as a last resort, demonstrating the provider's commitment to less restrictive approaches.

A staff member told us, “We always look for what someone can do before thinking about what support they need. We review things regularly because we don't want restrictions in place any longer than necessary." The impact of this approach was significant. People experienced greater independence, increased community involvement, reduced restrictions and improved quality of life whilst continuing to receive safe support.

The provider went beyond maintaining a safe environment by creating an environment specifically designed around people's individual needs whilst promoting independence and positive outcomes. Safety systems were highly proactive, evidenced through comprehensive audit programmes, immediate action following identified concerns, evidence-based equipment assessments and personalised environmental adaptations.

People were supported in an environment that was consistently safe, well maintained, and adapted to meet their individual needs. The provider had embedded systems to identify, assess and manage environmental risks whilst promoting independence and positive risk-taking. There was a strong culture of proactive oversight, with leaders using audits, risk assessments and learning to ensure the environment remained safe and responsive to people's changing needs.

The service demonstrated a highly proactive approach to environmental safety. Comprehensive audits were completed routinely and monitored through governance dashboards and action plans. Monthly health and safety assurance processes, such as regular fire alarm testing, and environmental audits ensured potential risks were identified and addressed promptly.

People lived in an environment that had been thoughtfully adapted to support their safety, wellbeing and independence. Bedrooms were personalised with memory boxes including items of sentimental value to people and references to their previous working lives through photographs and/ or personal items. People’s environments were personalised with sentimental décor and recognisable room doors. A health professional told us these personalised environmental adaptations were unusual and reflected the provider's commitment to understanding people as individuals. This also supported orientation and meaningful conversations for those people living with dementia. Accessible handrails and dementia-friendly design features enabled people to move around safely whilst maintaining freedom and independence.

The provider demonstrated exceptional oversight of equipment and environmental safety. Regular servicing and maintenance of hoists, lifts, boilers, wheelchairs, evacuation equipment and specialist pressure-relieving equipment was completed. Mattress and cushion audits used evidence-based assessment tools aligned with NHS guidance, with failed equipment replaced immediately. This reduced the risk of avoidable harm and ensured people had access to equipment that remained suitable for their needs.

Environmental risks were managed through highly personalised assessments. All people had Personal Emergency Evacuation Plans (PEEPs), individual fire risk assessments and detailed support plans which were reviewed regularly and updated when needs changed. Staff demonstrated a clear understanding of people's risks and how to support them safely during emergencies. Emergency preparedness arrangements included contingency planning for power failures, staffing shortages and severe weather events to ensure continuity of safe care.

Leaders continually reviewed environmental safety through robust governance systems. Audit findings were tracked through action plans, with progress monitored through quality assurance dashboards. Learning from incidents, environmental concerns and feedback was used to improve safety and drive continuous improvement. This demonstrated a culture where risks were proactively identified and addressed before they impacted on people.

Leaders demonstrated a strong understanding of people's needs and used innovative approaches to ensure staffing levels, skills and deployment remained aligned to changing levels of dependency and complexity. Staff were fully supported and valued which enabled them to work together seamlessly so people consistently received safe, responsive and person-centred care tailored to individual needs.

Staffing levels were continually reviewed using a dependency tool and additional oversight processes which enabled leaders to respond proactively when people's needs changed. Rather than relying solely on predetermined staffing numbers, leaders regularly evaluated people's current support requirements and adjusted staffing arrangements accordingly. This ensured people consistently received timely, person-centred support.

People benefited from a stable and consistent staff team who knew them exceptionally well. Relatives repeatedly commented on the continuity of care provided and the positive relationships people had developed with staff. One relative told us, "They love my mum. The staff members are consistent; they all have a good relationship with her." Families explained this consistency helped people feel reassured, particularly those living with dementia who benefitted from familiar faces and established relationships. Staff turnover was low and leaders had worked proactively to maintain workforce stability.

The service demonstrated an exceptional commitment to ensuring staff possessed the skills, knowledge and confidence necessary to support people effectively. Staff completed comprehensive induction programmes, competency assessments and ongoing learning tailored to people's needs. Staff consistently spoke positively about the quality of training and described how learning improved their ability to support people safely and effectively. One member of staff told us, "The managers are always looking at what training we need based on the people we support." The combination of stable staffing, exceptional training, visible leadership and recognition of staff strengths enabled people to experience consistently safe, personalised and responsive care.

The service also demonstrated innovative approaches to workforce development and staff enablement. Staff contributed to quality improvement work, handover redesign projects, dignity initiatives and governance activities. Leaders recognised individual strengths and actively supported staff to develop specialist interests and areas of expertise. This created a highly engaged workforce that felt valued and invested in delivering outstanding care. Staff comments included, "The managers are really good at recognising what people are good at. If you've got an interest or strength in an area, they encourage you to develop it and share it with others. They listen to ideas and give you opportunities to lead on things you're passionate about."

Staff consistently reported feeling supported by leaders and colleagues. Supervisions, competency reviews and wellbeing discussions were completed regularly and provided opportunities for reflection, development and support. Staff described a positive and inclusive culture where teamwork was prioritised and where they felt able to seek guidance, share concerns and learn from one another. Following incidents, leaders facilitated reflective debriefs to support staff wellbeing and ensure learning was embedded across the service.

Recruitment processes were robust and exceeded minimum regulatory requirements. The provider used values-based recruitment approaches. This helped ensure staff shared the values of the service and possessed the necessary skills to provide safe and compassionate care.

Healthcare professionals and families consistently praised the knowledge, competence and responsiveness of staff. Professionals described staff as, “Highly skilled”, “Knowledgeable about people's needs” and “Proactive when concerns arise.” Families told us they had, “Confidence in staff's abilities” and felt, “Reassured knowing [name of person] is supported by experienced and caring staff.”

The provider demonstrated an embedded, proactive and continuously improving infection prevention and control culture. They quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly. Leaders had created a strong culture where preventing infection was viewed as everyone's responsibility and was supported through robust governance, rigorous auditing, continuous learning and responsive improvement.

People lived in a clean, safe and welcoming environment where risks associated with infection were minimised. Relatives consistently described the home as “spotlessly clean", demonstrating the confidence people and those important to them had in the service. During the inspection we observed environments were clean, clutter free, odour free and well maintained.

Systems to prevent and control infection were comprehensive and proactively monitored. The provider completed regular hand hygiene, environmental, mattress, cushion and Infection Prevention and Control (IPC) audits using structured tools, with clear action tracking and management oversight. Audit findings were reviewed through governance systems and improvements were implemented promptly. Where equipment or furnishings did not meet expected standards, action was taken immediately, including replacement where necessary. This demonstrated a culture of continuous improvement rather than compliance alone.

Staff had access to fully stocked Personal Protective Equipment (PPE) stations, clear infection control guidance and regular competency assessments. IPC training compliance was high, with refreshers and competency reviews actively used to maintain standards. Staff across all departments, including care, domestic, laundry and kitchen teams, were involved in maintaining safe infection control practices. This whole-service approach helped ensure consistent and exceptionally high standards of cleanliness and hygiene were maintained throughout the home.

Leaders also demonstrated a proactive approach to improvement. For example, they identified that excessive glove use during mealtimes could create barriers to meaningful interaction and dignity for people. Rather than accepting existing practice, they reviewed procedures, provided guidance and promoted proportionate PPE use to balance infection prevention with compassionate care.

The service responded effectively to emerging risks. There was a comprehensive annual audit programme, monthly IPC focus topics and clear action plans. Learning from incidents, wider sector events and audit findings were used to strengthen practice. Business continuity arrangements ensured PPE, cleaning products and infection control resources remained available during periods of increased demand or outbreak situations.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.

The service had systems in place to safely store, administer and record the use of medicines. The service had individual fire risk assessments in place for people who were prescribed paraffin-based skin products. The use of topical creams and ointments were recorded on the electronic medicines administration records (eMARs). Body maps were in place to show staff the site of application.

Thickeners used to thicken fluids for people with swallowing problems were recorded when they had been used. Some people were prescribed a medicine administered via a patch which needs rotating to different areas of the body, as recommended by the manufacturer. There was a process in place to indicate the site of application to prevent the patch being placed on the same site too frequently.

We checked the quantities and stock balances for 7 people and found them all to be correct. Instructions for medicines which should be given at specific times were available. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, known as “PRN” was available to staff.

For people given their medicines covertly (disguised in food or drink). Appropriate assessments had been undertaken, and documentation was in place to ensure these were given appropriately and safely. Liquid medicines had the date of opening recorded on their labels, which reduces the risk that medicines could be administered beyond their once‑opened expiry date.

There were appropriate arrangements in place for the management of controlled drugs and staff completed regular balance checks. Temperature records to ensure the safe storage of medicines were completed in accordance with national guidance.

There was evidence that there was a process in place to record medicines related incidents or errors. Staff told us they had completed a training and induction process for medicines management. Staff competencies were assessed regularly to make sure they had the necessary skills.

Managers and members of staff qualified to handle medicines regularly completed audits (checks) to make sure that procedures were followed.